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DSH440050R TAKOMA REGIONAL HOSPITAL (Terminated)
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Main Details
Name
TAKOMA REGIONAL HOSPITAL
Subdivision Name
TAKOMA MEDICAL ASSOCIATES / Cardiovascular Associates
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440050R
Medicare Provider Number
440050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/4/2015
Last Recertification Date
11/9/2017
Termination Date
Termination Reason
4/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Ballad Health
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Primary Contact
Wellmont Health System
ALLAN SHARP, PHARMACIST
(423) 578-8541
Addresses
Street Address
1021 Coolidge Street
Suite 5
Greeneville, TN 37743-7202
Billing Address
WELLMONT HEALTH SYSTEM
PO BOX 659
KINGSPORT, TN 37662
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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